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SSRI-induced extrapyramidal
side-effects and akathisia: implications for
treatment.
Lane RM.
Pfizer Inc., New
York, NY 10017, USA. laner@pfizer.com
The selective serotonin
reuptake inhibitors (SSRIs) may occasionally induce extrapyramidal
side-effects (EPS) and/or akathisia.This may be a consequence of
serotonergically-mediated inhibition of the dopaminergic system.
Manifestations of these effects in patients may depend on predisposing
factors such as the presence of psychomotor disturbance, a previous
history of drug-induced akathisia and/or EPS, concurrent
antidopaminergic and/or serotonergic therapy, recent monoamine oxidase
inhibitor discontinuation, comorbid Parkinson's disease and possibly
deficient cytochrome P450 (CYP) isoenzyme status. There is increasing
awareness that there may be a distinct form of melancholic or endogenous
depression with neurobiological underpinnings similar to those of
disorders of the basal ganglia such as Parkinson's disease. Thus, it is
not surprising that some individuals with depressive disorders appear to
be susceptible to developing drug-induced EPS and/or akathisia. In
addition, the propensity for the SSRIs to induce these effects in
individual patients may vary within the drug class depending, for
example, on their selectivity for serotonin relative to other
monoamines, affinity for the 5-HT2C receptor, pharmacokinetic drug
interaction potential with concomitantly administered neuroleptics and
potential for accumulation due to a long half-life. The relative risk of
EPS and akathisia associated with SSRIs have yet to be clearly
established. The potential risks may be reduced by avoiding rapid and
unnecessary dose titration. Furthermore, early recognition and
appropriate management of EPS and/or akathisia is required to prevent
the impact of these effects on patient compliance and subjective
well-being. It is important that the rare occurrence of EPS in patients
receiving SSRIs does not preclude their use in Parkinson's disease where
their potentially significant role requires more systematic
evaluation.
Publication Types:
PMID: 9694033 [PubMed - indexed for
MEDLINE]
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